Information for healthcare professionals in Sweden only.

Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?

Study by S. Dreborg, X. Wen, L. Kim, G. Tsai, I. Nevis, R. Potts, J. Chiu, A. Dominic and H. Kim. In Allergy, Asthma & Clinical Immunology 2016 12:11.

Background

Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis.

The researchers examined if children and adolescents at risk of anaphylaxis weighing 15–30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available epinephrine auto-injectors in North America and Europe.

Methods

The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure (_max) or slight pressure (_min) in:

• 102 children weighing 15–30 kg (group 1)
• 100 children and adolescents, weighing more than 30 kg (group 2).

Results

Group 1, 15-30 kg:

• Using a high pressure EAI - Epipen Jr® and Auvi-Q®/Allerject® 0.15 mg - 11 % children had a STMD_max that showed a risk of intraosseous injection.
• Using another high pressure EAI - Jext® - 38 % had a STMD_max that showed a risk of intraosseous injection.
• There was a 1 % risk of subcutaneous injection with these devices.
• Using a low pressure EAI, Emerade®, there was no risk of intraosseous injection.

Group 2, more than 30 kg:

• Using a high pressure EAI, the risk of intraosseous injection was 3 %.
• Using a low pressure EAI, such as Emerade, there was no risk of intraosseous injection.
• However, the risk of subcutaneous injection using a high pressure EAI was 9 % and using a low pressure EAI was 2 %.

Conclusion

There is a risk of intraosseous injection using high pressure EAI (Epipen®/Epipen Jr®, Auvi-Q®/Allerject® and especially Jext®) in children at risk of anaphylaxis.

There was also a risk of subcutaneous injection using the currently available high pressure EAI in children and adolescents.

Read the full study in Allergy, Asthma & Clinical Immunology Journal

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